They Haven't Thought About It! - A Physician's Response to MACRA

Physicians now have to do a lot of work (for not a lot of money) in order not to be penalized for something we are doing now anyways.

MACRA is a new initiative passed by our federal government mandates that doctors across all specialties attest to doing something meaningful. This means that going forward a physician’s compensation will not be only tied to fee-for-service anymore, but it's going to be tied to the quality of work.

What does that mean? The truth is: no one knows exactly.

MACRA is very, very complex. The initiative proposes many ways that physician can attest to their competency. And no, I'm not talking about medical competency! Oh no, nobody cares about that!

Medicare cares about you doing meaningful work. Basically, meaningful paperwork!

The things that you already do in your office, in your hospital, and with your patients will now have to be shown again to the federal government. Now, you will have to jump through hoops to show that you're taking your patients blood pressure, that you are checking their vitals, and that you given them the right medications for the right conditions. Basically, you are guilty until you're proven innocent.

And why do we need to do any of this?

Well, because if you don't your Medicare payments will be cut. In order to get the same payment that you're getting right now you have to do more work and you have to show our government that what exactly you are doing. Now, some of those things your office should already be tracking, especially if you are already using an electronic health record. (If not, it’s time to start!) You now just have to attest to to those basic markers.

But on top of that, now you have certain modules you have to do, like ‘Improvement Activity’ for instance, where you have to show Medicare that you're going to be a better doctor.

And no, not that you're not going to better at saving patients' lives, but that you’re going to be a better… pencil pusher!

Rather, you are going to improve at recording things that you are going to be doing to patients. This sounds kind of stupid, because it is.

There's not one single study. There is no research or evidence that doing any of this improves patients' care or outcomes. (or saves money!)

But the federal government felt like there was a need to stop paying fee-for-service and start paying for ‘quality’ because this is the thing to do, I guess?

I don't know how physicians were consulted, or how many medical groups approved this idiotic new initiative, but now we all have to do it. So now, we have to take time from seeing patients, and we have to spend a lot of hours in front of computers - with consultants and various mid-level providers who tell us how to record something that we're already doing and how we show Medicare that we already doing this or that.

Now the upside is that if you do do it, if you do attest,  then your payments will not be cut and you'll be getting the same what you're getting right now.

But, the truth is is that all of these systems are based on the fact that somebody must suck! Why?

Let's say you, as a practicing doctor, are doing a great job attesting to something you do. And let's say you're doing a fantastic job of telling Medicare how you're gonna improve your services and you're doing it all correctly.

(I don't know how, but somehow you figured it out the Medicare portal - which by itself is a nightmare! You need a degree in computer science, business, and economics to understand how to even get an ID for Medicare to log onto their portal, but I digress.)

You're a doctor or provider who does it all correctly. But let's say I am a doctor that does not comply with MACRA! Let's say I don't do anything, and I don't attest. I don't want to do any of this so I'm going to take a penalty.

In the ideal world if you did everything right as far as attesting and I did nothing then in a year, or two, or three (it's hard to understand Medicare) YOU will get a bonus and I will get a cut. So, because I suck, you benefit.

Well, what's going to happen if everybody sucks?  Well, I don't think they thought about it, but if everybody sucks then everybody doesn't get any money, right?

And what’s going to happen if everybody's great? What if every single provider in this country decides to go online and spend 20 hours a month just pacifying Medicare, and attesting to information we already gathered anyway? If everybody does it, then who gets the bonus? Who will the money be taken away from?

They didn't think about it either.

So now, physicians have to do a lot of work (for not a lot of money) in order to not to be penalized for something we're doing now anyway. What puzzles me the most is the fact that vast majority of physicians in this country simply take it. They complain about it and they don't like it, but there's no centralized movement or physician outcry about the complete idiotic nature of this business!

Look, we're already busy.We're seeing patients. We're trying to improve patients' lives. We have other responsibilities - the various certifications we have to keep up with, the literature and journals, and CME. And now we have to do this.

So my question to you is: when are you going to say that "Enough is enough!"

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